There are several types of breast cancer, but some of them are quite rare. In some cases a single breast tumor can have a combination of these types or have a mixture of invasive and in situ cancer.

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.

When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with necrosis.

Lobular carcinoma in situ

Although it is not a true cancer, lobular carcinoma in situ (LCIS; also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer, which is why it is included here. It begins in the milk-producing glands but does not grow through the wall of the lobules.

Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast. For this reason, women with LCIS should make sure they have regular mammograms and doctor visits.

Invasive (or infiltrating) ductal carcinoma

This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 of 10 invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.

Less common types of breast cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the breast skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy. In its early stages, inflammatory breast cancer is often mistaken for an infection in the breast (called mastitis). Often this cancer is first treated as an infection with antibiotics. If the symptoms are caused by cancer, they will not improve, and the skin may be biopsied to look for cancer cells. Because there is no actual lump, it may not show up on a mammogram, which may make it even harder to find it early. This type of breast cancer tends to have a higher chance of spreading and a worse outlook than typical invasive ductal or lobular cancer. For more details about this condition, see our document, Inflammatory Breast Cancer.

Triple-negative breast cancer: This term is used to describe breast cancers (usually invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. (See the section, "How is breast cancer diagnosed?" for more detail on these receptors.) Breast cancers with these characteristics tend to occur more often in younger women and in African-American women. Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer. Because the tumor cells lack these certain receptors, neither hormone therapy nor drugs that target HER2 are effective against these cancers (but chemotherapy can still be useful if needed).

Mixed tumors: Mixed tumors contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. In this situation, the tumor is treated as if it were an invasive ductal cancer.

Medullary carcinoma: This special type of infiltrating breast cancer has a rather well-defined boundary between tumor tissue and normal tissue. It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor. Medullary carcinoma accounts for about 3% to 5% of breast cancers. The outlook (prognosis) for this kind of breast cancer is generally better than for the more common types of invasive breast cancer. Most cancer specialists think that true medullary cancer is very rare, and that cancers that are called medullary cancer should be treated as the usual invasive ductal breast cancer.

Metaplastic carcinoma: Metaplastic carcinoma (also known as carcinoma with metaplasia) is a very rare type of invasive ductal cancer. These tumors include cells that are normally not found in the breast, such as cells that look like skin cells (squamous cells) or cells that make bone. These tumors are treated like invasive ductal cancer.

Mucinous carcinoma: Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells. The prognosis for mucinous carcinoma is usually better than for the more common types of invasive breast cancer. Still, it is treated like invasive ductal carcinoma.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.

Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or, more often, with infiltrating ductal carcinoma. Treatment often requires mastectomy. If only DCIS is found (with no invasive cancer) when the breast is removed, the outlook is excellent.

Tubular carcinoma: Tubular carcinomas are another special type of invasive ductal breast carcinoma. They are called tubular because of the way the cells are arranged when seen under the microscope. Tubular carcinomas account for about 2% of all breast cancers. They are treated like invasive ductal carcinomas, but tend to have a better prognosis than most breast cancers.

Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope. These tumors can be separated into non-invasive and invasive types. Intraductal papillary carcinoma or papillary carcinoma in situ is non-invasive. It is often considered a subtype of ductal carcinoma in situ (DCIS), and is treated as such. In rare cases, the tumor is invasive, in which case it is treated like invasive ductal carcinoma, although the outlook is likely to be better. These cancers tend to be diagnosed in older women, and they make up no more than 1% or 2% of all breast cancers.

Adenoid cystic carcinoma (adenocystic carcinoma): These cancers have both glandular (adenoid) and cylinder-like (cystic) features when seen under the microscope. They make up less than 1% of breast cancers. They rarely spread to the lymph nodes or distant areas, and they tend to have a very good prognosis.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the tumor along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these cancers may not respond as well to the other treatments used for more common breast cancers. When a malignant phyllodes tumor has spread, it may be treated with the chemotherapy given for soft-tissue sarcomas (this is discussed in detail in our document, Soft-tissue Sarcomas.

Angiosarcoma: This is a form of cancer that starts from cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section, "How is breast cancer treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas. See our document, Sarcoma - Adult Soft Tissue Cancer.

I do not seek to inspire you, or move you with my words.  I simply would like to tell you a couple of things that come to mind.  First, please do not ask how she passed away.  It may come across as morbid, but with the lack of understanding loss and how we fear death as a society; it’s clear in every person I meet. I came to the realization at a young age that life is not eternal. The more important question should always be how she was during her life.  You will find that all of the inspiring stories, funny anecdotes and embarrassing moments lied behind that simple question. 

So to answer the question, “How did she pass away?” is simple.  Her battle lasted close to two years. After the first year she went into remission and I thought that it was all over.  I was thirteen at the time and I was glad that we could put all of that behind us. I wanted to move forward, enjoy other things, something else than doctor visits, chemo, sleepless nights with frequent visits to the emergency room.  Very little was explained to me at the time and even less was talked about amongst my family after her death.  In retrospect, as successful and well educated as my family was, they had little understanding of the situation or how to explain it to me.  So they found comfort in the idea that some things were best not be said.

July 8^th, 1990 at 12:48am she ceases to be present.  That is the time and date that was stamped on her chart.  The truth was that she took her last breath six minutes before that.  Like I said, I was thirteen at the time and my emotions understood the matter at hand less than I did.  I had been staying at the hospital for 2 days, at a separate wing for hospice patients; before advantages of cells phone, texting, IM, or a clear understanding of what hospice was and how they help us.  A landline in an empty waiting room late on the night of the 7^th was something that gave me comfort.  I talked to a girl I liked for hours.  Nothing that important I can imagine now. I hung up the phone around 12:30am and walked to my mother’s room.  Her sister was sleeping in a bed next to her.  The door to her room remained open and illuminated by a dim hallway light, which made it easy for me to find my way into a hospital reclining chair.  The clock on the wall and the sound of my mothers’ breath was the only thing that I could manage to focus at that moment.

12:42am was what the hands of the clock read. Six minutes after that a nurse came to tell me what I already knew.  It has taken me 21 years to understand those six minutes. Why I did not move or call for help? Was I bad son for not moving? Clarity can come from the most unusual people in the most unexpected times in your life.  Mine came from two girls both survivors in their own way.  One lives a constant battle with multiple sclerosis.  She said to me one day, as she explained what she faces every day, that even if we are dying and our bodies seem to be fading everyday, does not mean that our spirits should do the same.  We always want to keep some dignity, it is human nature. She highlighted that the memories of my mother that I need to remember should be the ones before her illness and not the struggle she faced. I had to accept what was inevitable.  So should I blame her for not wanting to talk about what was going on?  No need to worry about the things we can not change. It was typical of her; she was a beautiful strong minded woman. What she faced was not easy for her and she embraced it with the respect it deserves. I know she did what she considers to be best for me in the end. 

My second moment of clarity and the one that got me a step closer to the idea of closure came during dinner with a friend, a girl that had lost a close friend recently to breast cancer.  She is an endurance athlete like I hope and aspire to be.  She said to me,” In any race it is just you, prepare the best you can and when your moment comes, you perform, simply do what you have been training for.”   A marathon is personal; you cannot expect to run it with someone by your side, you simply need to find a pace that works for you.  I am fascinated with all that our body and mind can endure.  Life is like a marathon, in every step there is a sense of fear and anticipation to the finish line.  We go through it numb, unaware of what is going around us, but we do it. Not for glory, fame, or because we have to. I have never met anyone that just runs 26.22 miles just to simply do it.  The meaning is personal, it is up to you to find the why.  The only shame that I realize is that we forget that the journey is as important and meaningful as your final destination.  

In the end, I did not need to find closure. That may be because I found it, but I can assure you that it does not feel like that some days.  People often do not know what they are talking about when it comes to death and loss.  The one sure thing you can say about death and loss is that there isn’t much you know about it. Not that you should not try, you can make analogies and work to find meaning in all of it.  Find joys in how they lived, find joy in how you live; because every step you take is one closer to your own personal finish line. Usually if someone asks me how my mother died, I would say, “painfully and pumped full of drugs, hopefully aware that we were by her side”. So I would encourage you all to ask, “Tell me how she lived”.   After all life is race and you just need to find your sweet pace.

Sincerely yours,

An Endurance Athlete